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HealthPayerIntelligence News

HHS Sets Sights on Addressing Social Determinants of Health

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Speaking at the Hatch Foundation for Civility and Solutions in Washington, DC, early this month, Azar pointed to social determinants of health as “the root cause of so much of our health spending,” contributing to the $1...

Data from Health Plans, PBMs Helps Lower Prescription Drug Costs

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The health information network Surescripts is using data from both payers and PBMs to give prescribers access to patient-specific and formulary-based benefit and cost information for nearly three-quarters of all covered lives in the...

Regulatory Uncertainty Continues to Disrupt ACA Marketplaces

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New research published by the Kaiser Family Foundation provides insight into the forces driving health payers to participate in certain ACA marketplaces while wholly quitting others. Insurer participation in the Affordable Care Act health...

HHS Looks to Medicaid Demonstrations to Improve Mental Health

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Medicaid beneficiaries with mental health conditions are the targets of recent CMS efforts to boost health outcomes. In recent remarks to the National Association of Medicaid Directors in the national capital, HHS Secretary Alex Azar said...

CMS Demonstrations Target Mental Health Services Under Medicaid

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Medicaid beneficiaries with serious mental illness (SMI) or serious emotional disturbance (SED) are the targets of recent CMS efforts to improve health outcomes. In a letter to Medicaid directors across the country, the federal agency...

Addressing Healthcare Literacy Key to Health Plans Reducing Costs

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The inability of consumers to successfully navigate the healthcare system, which costs employers and health plans billions in administrative costs. In a recent article in the Harvard Business Review, members of Accenture’s...

Robocalls Targeted Consumers During Health Plan Enrollment Period

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Health insurance open enrollment’s kicked off, accompanied by a spike in automated calls with offers of Affordable Care Act or other health plans, much to the chagrin of consumers. “It’s at epidemic levels at this time...

FTC Clamps Down on Allegedly Fraudulent Health Plans

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A federal judge temporarily closed a Florida-based firm accused of fraudulently collecting over $100 million from Americans. Simple Health allegedly collected more than $100 million by preying on consumers shopping for health insurance by...

HealthCare.gov Breach Exposes Data of 75K Individuals

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Last month, a breach of HealthCare.gov took place that affected those applying for coverage under the Affordable Care Act, HHS reported last Friday. The intrusion led to inappropriate access to the personal information of about 75,000...

Strategies for Designing Consumer-Centric Health Plans

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The Health Care Transformation Task Force recently released a new set of guiding principles to help healthcare industry leaders and policymakers better integrate consumer needs into benefit design. The goal of the task force, a consortium...

CMS Proposes to Deregulate, Fast Track Medicaid Managed Care Programs

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CMS has proposed a new rule to reduce regulation around Medicaid managed care programs and allow states to contract with private payers to deliver managed care at faster rates. CMS developed the rule in coordination with the National...

CMS to Audit Premium Subsidy Eligibility for Individual Health Plans

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CMS has proposed a new rule that would audit premium subsidy eligibility for individual health plan beneficiaries and monitor premium assistance programs through the federal insurance exchanges. The Patient Protection and Affordable Care...

US District Court Denies Appeal to Resolve Risk Corridor Payments

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Federal judges for the US Federal District Court of Appeals denied a request to reopen a case that could provide over $12 billion in risk corridor payments to payers. Moda Health Plan, BlueCross BlueShield of North Carolina, and Land of...

Employer-Sponsored Medicare Advantage Enrollment Up 12% for 2019

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Employer-sponsored Medicare Advantage (MA) enrollment for plan year 2019 increased by 12 percent, representing a bump of more than 443,000 individual members, according to a new analysis by Mark Farrah Associates. Individual Medicare...

Poor Data Quality in CA Medicaid Drives $4B in Improper Payments

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California's Medicaid program, Medi-Cal, made over $4 billion in improper payments to cover benefits for ineligible beneficiaries because of poor data quality and insufficient oversight, according to a new report from state...

Commercial, Managed Care Insurance Sectors Profits Boom in Q3

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Commercial and managed care payers experienced significant third quarter profits, reductions in healthcare spending, and enrollment growth, according to the latest financial statements from insurance companies. Medicare Advantage (MA),...

Retail Clinics, Surprise Bills Changing Healthcare Purchasing Patterns

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Consumers are changing the way they spend their healthcare dollars as the stress of surprise medical bills, coupled with new retail-style options, change the care delivery landscape. Two new consumer surveys reveal that changing...

BCBSAZ Shared Savings Program Reduces Hospital Readmissions by 26%

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BlueCross BlueShield of Arizona’s (BCBSAZ) shared savings program has reduced 30-day hospital readmission rates by 26.3 percent while generating shared savings for providers.. BCBSAZ also reported 15.2 percent fewer ED visits per...

CMS Redesigns Medicare Home Health Payment with Case Mix Model

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CMS has proposed a new rule that would recalculate Medicare home health payments using a case mix payment model.   In 2020, the agency plans to implement the Patient-Driven Groupings Model (PDGM) to compensate home health agencies...

Consumer Demand for High-Deductible Health Plans Dwindles

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Consumer demand for high-deductible health plans (HDHPs) is expected to decline in 2019 as more beneficiaries look for health plans with customized benefits instead, according to a new survey from Oliver Wyman. Half of consumers surveyed...

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